HomeMy WebLinkAboutHIGHLAND TERRACE #4 LT 6C1Hl"ghland
Terrace 4
Lot 6C� I
#050�31 1 �28
L 0 U N S B U R Y & A S S 0 C I A T E S , I N C .
E N G I N E E R S PLANNERS
September 21, 1.984
S U R V E Y 0 R S
municipality of Anchorage
Health & Environmental
Protection Department
825 "L" Street
723W 6th AvenUe, Anchorage, Ak 99501 Tel (907)272-5451
105-e C t6��l
mchorage, mn. vvjU
Attention: John Lynn
(4j
Dear John: Y/
This letter is a request for a Preliminary Review of the proposed
subdivision of Trct G -C. Highland Terrace Subdivision. The tract
is 5.9 acres, zoned R-6, and has a house located on the northern
,portion. We propose to subdivide the tract into two lots; one 4.4
acres with the existing houser and one 1.5 acres. The 1.5 acre
lot is very steep, but we feel we can demonstrate three absorption
field locations. It is difficult to demonstrate these locations
graphically and would therefore like to go to the tract with you
or a member of your staff -to go over our plans.
Enclosed are a copy of the Preliminary Plat and percolation test.
Please call, and let me know when would be convenient to visit the
site.
Sincerely,
LOUNSBURY & ASSOCIATESr INC.
Engineer
is/sw
Enclosures: As noted
IEWITT V. LOUNSBURY & ASSOCIATr
ENGINEERS — SURVEYORS
723 W. 6th Avenue — Anchorage, Alaska 99501 — Phone 272-5461
DATE DATE
SIGNED SIGNED
Redifprme 4S 473 SEND PARTS I AND 3 WITH CARBON INTACT - PART 3 WILL Of RETURNED W1111 REPLY,
A,
I ij I
Y
P 4 1 0- 01 1 /
7'em n, �e M'
/-; 0 L"r-e-
AS-BUILT
I hereby certify that I have surveyed the following
described property, I—EA C 7— (�� C I -
-r_'C'--rOL cno- :;_ai -J, A�',,��
improvements 3ituated thereon are within the property
lines and do not overlap or encroach on the property
lying adjRcent thereto, that no improveme
erty lying adjucent thereto encroach on tht
question and thnt there are no roadways,
Imes or affier viajble easements on said property except
as indicated hereon.'
Daited at !L41c River, Al,-qka
Y
thj&_�2��' da of 0 Sn
ROBFUT C. JOHNSON
SCAM RcgilsiunvAl Land Surveyor No. 880 -LS
1" 00 Box 450 Mgle Riveri A.Jaska
- Phone 44-2543
S ZITZ�,
& ENGINEERS, INC. SOIL LOG
S
7125 OLD SEWARD HIGHWAY
ANCHORAGE, ALASKA 99502 PERCOLATION TEST -BEDROOMS
(907) 349-6561 JOB NUMBERAO-S'7- 9
PERFORMED FOR:
—DATE PERFORMED�
LEGAL DESCRIPTION:--�fi-4�--4qLA/���R,4Le _T,#EAC-rj� �4 �P�- �(W
SLOPE SITE PLAN
-TRACE 0CANIa o
3n,"DV (5jQAIJL-��
2 16
WITH -SOMIE '��JL�r
3 —
4 —
0 WELL 6)QAj)st> / Lo cn�4
pll�' GM
"X�
5
Sai L:D erz C,
6
7
17' SOIL LOG 2�
It,"
PERCOLATION
TEST
8 <
9
10-
11
12:rc
13 '0
14
I
J,
V
16
17
113— IP, %
19—
A
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
z
U)
&ATI
S
L
0
P
E
40/o
IF
Reading Date Gross
Time
Net Depth to
Time Water
Net
Drop
2.
fA/.q
14 CA 3>/,q
7S &A I&
-9-
AA I 1-�
DEPTH PERCOLATION RATE- 'minuteslinch)
(FEET) TEST RUN BETWEEN 4- 1.5 FT AND FT
COMMENTS l4biZ KC_c4DAj_-M 7WICC
Z00 /Se, — GOIL t-OOSE
PERFORMED BY: M IYNN ISTER ___ CERTIFIED BY: DATE:
72 � (91831
u
P1 1174 X C-1 X F7*"O-"-) L- 1 01 P- Pit Iq IC;11-11 C11 IFc I(, -,h C3 IL;H'm
DEPART�I-NT OF H"'ALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHQRAGE, AK 9950l
264-4720
���I 'T �� L.,.: f I I I I F; z �U., [.,-. k— �����W-11 1 'Y
PERMIT NO: 840552
DATE I61'.)UED: 07/10/84
APPLICANT: DEBRA UPTEGRAFT
AD1)RESS3500 MTN VIEW DRIVE-" SPHCE 37
ANCHORAGE, AK 99508
CONTACT PHONE: 694-2124
I certify that:
1" I am familiar with the requirements for on-site sewers and wells ag set.
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2" I will install the system in ac--:cordanc:e with all MOA codes and regulations,
and in compliance with the design criteria of this permit"
3" I will adhere to all MOA and State of' for, the set back
distances from any existing well, wastewater disposal systeM) C-11' �ublic
,Gem8PaQe 1ry5;tC?m on this or any adj@cent or neapby Iot^
4, I Understand that thir� permit is valid f or a maximum of 3 bedPooms and
any enlargement will require an aclditional permit"
IF A LIFT STATION IS INSTALLED IN AN AREA QY MOA BUILDING CODESq,
THEN (1) AN
ELECTRICAL PERMIT AND
INSPECTION MUST BE OBTAINED: (2) AS-BUILTS
BLOCK: NA
APPFOVED WITHOUT AN ELECTRICHL
INSPECTION REPORT;
AND (3> THE
ELECTRI��AL
WORK MUST BE DONE BY A
LICENSED ELECTRICIAN"
SIGNED
~���_���_�_~_~��_~.���_�.~~~_
DATE:
'
APPLICANT:
L.zsceo below are the options
avazl.ab1e to
igoing
your septic
system. Choose the option that
best fits
e.
��r7z". jt'-�
WWF� gCA T. 11"'ll
uEr/l-I ,u r11PEE OU||UM
4 0
4.0
4.0
8RAVEL D[�PTH (FT
0"5
3.5
TOTAL. DEPTH (F
`
4"5
7^5
GRAVEL WIDTH (
22"0
5"0
GRAVEL LENQTH
\��.0
41.0
65"0
GRAVEL VOLUME YDS.
31.2
33.4
48.1
TANK SIZE (GALS)0
*�
SOIL QATIWG (SQ"FT R) 200
197
200
** TANK MUST HAVE TTWU
COMPA��TMENTS
I certify that:
1" I am familiar with the requirements for on-site sewers and wells ag set.
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2" I will install the system in ac--:cordanc:e with all MOA codes and regulations,
and in compliance with the design criteria of this permit"
3" I will adhere to all MOA and State of' for, the set back
distances from any existing well, wastewater disposal systeM) C-11' �ublic
,Gem8PaQe 1ry5;tC?m on this or any adj@cent or neapby Iot^
4, I Understand that thir� permit is valid f or a maximum of 3 bedPooms and
any enlargement will require an aclditional permit"
IF A LIFT STATION IS INSTALLED IN AN AREA QY MOA BUILDING CODESq,
THEN (1) AN
ELECTRICAL PERMIT AND
INSPECTION MUST BE OBTAINED: (2) AS-BUILTS
WILL NOT BE
APPFOVED WITHOUT AN ELECTRICHL
INSPECTION REPORT;
AND (3> THE
ELECTRI��AL
WORK MUST BE DONE BY A
LICENSED ELECTRICIAN"
SIGNED
~���_���_�_~_~��_~.���_�.~~~_
DATE:
'
APPLICANT:
D" -BRA UPTEGRhFT
___~~~�~~_____~
ISGUED BY
DATEx //�o
��tL
�
SOILS LOG
MUNICIPALITY OF ANCHORAGE
PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
1� or 825 L. Street, Anchorage, Alaska 99501 264-4720
N
n, SOILS LOG PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED: /(9 ZZO Aq
LEGAL DESCRIPTION: J/ 0/r -17 L t I I %� I/ 4�� `� i��, CZJTr P1 AN
(!� rf e't' /,I / C
T(I -'5'1) A-0
I
�-/ L, 7-
A
ftRI-UHMt:U
twil
77'.
WAS GROUND WATER
ENCOUNTERED? Z�o
IF YES, AT WHAT
DEPTH?
Reading
Date
Grosz
Time
Not
'rime
Depth to
Water
Net
Drop
16 -
'o
49'
too 0.0, *.*j -v
17 -
18-
to
No, 1457-E
19-
P A
%0% IL
ftRI-UHMt:U
twil
77'.
WAS GROUND WATER
ENCOUNTERED? Z�o
IF YES, AT WHAT
DEPTH?
Reading
Date
Grosz
Time
Not
'rime
Depth to
Water
Net
Drop
S
Net
Time
&
ENGINEERS, INC.
S
7Q��
-1
GRA
'125 OLD SPh'ARD HIGHA'AY
ANCHORAGE, ALASKA 99502
SOIL LOG
-- SOIL LOG
PERCOLATION
TEST
PERCOLATION TEST -:SBEDROOMIS
(907) 349 6S61 JOB NUMBER: 4:: 0'-;� --� 9
PERFORMED FOR DATE PERFORMED.
-D-1�1 �A-UPT
LEGAL DESCRIPTION. _,e Z
(L :2_� k '�� I W�S,
SLOPE SITE PLAN
xl�
3
4
6
7
12
13
14
15
16
17
18
'19
20
6- T
L")o j— C )ieAD M-�, � L,) i, 7�4
A4
4 0 7
I A
A
2248-E
S GROUND WATER
NCOUNTERED'?
IF YES, AT WHAT
DEPTH?
z
LOR
S
L
0
P
E
w
q
f
f
w
Reading Gross
Dale Time
Net
Time
Depth to
Water
Net
Drop
6,� JOL 64'! -6)A, -up -
2. A'1� C
DEPTH. PERCOLATION RATE— (minuteslinch)
(FEET) TEST RUN BETWEEN -4—,5—F -T AND FT
COMMENTS 14pl-eeq
PERFORMED BY JZJ__,�AIVA DATE
CERTIFIED BY:
January 31, 1983
TO: Permit Applicant
�Peritlit 4 , 820804
Subject: Tra(-L 6C Highland Terrace Sub(liiisLon
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal ordinance.
if you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
if a private engineer inspected the installation all -f the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely
llpl�' cl"J�—
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
Irl 11 P-4 I i::- I F --a " L_ 1 -F r�e C -i IF-- F:l P-4 C--- " w -m F7-,!-, " 1:3 U
DEPARTMENT ( HEALTH AND ENVIRONMENTAL JTECTION
825 -OL, STREET� ANCHORAGE� AK 99501
264-4720
II ,l E=_- L_ IL_ n r-4 Ir -4 --!EF I -Y" IE-:- !EF U 11-4 IE�, F," ll`-� F-77 F;;.w Irl I ""r-
PERIlIT NO. ( 820804
APPLICANT DAVID ALLEN PO PDX 1432 E. R. 99577 694-21.24
LOCATI ON
LEGAL TR6C HIGHLAND TERRACE LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MF0X,Ir,lUrl NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 140
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E>F=F"'T"— "_-5m -4 Q- CA F -Z 0 V IEK L_ 0 UE IF� -r " !ff.
THE LENGTH DIMENSION IS THE LENGTH rIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TREENCH OR PIT IS, 'THE DISTANCE BETWEEN THE: SURFACE OF I -FIE
F
31.-�.,OUND AND THE BOTTOM OF' THE EXCAVATION (IN FEET).
THERE 15 NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF' GRAVEL BETWE-EN THE OUTFALL PIPE'
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F,;."U 0 U I Fn� U El- .0=5 U. F=" -IF I k:- -F 1=4 P-4 V--' '=-. 12! FE = A. CD 92, ID 13 F=� L_ L_ 0 1�4!F-
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
_r 11.4 f_-, < ., =_�: 4 ", B 'E F:::w EF K"---- -IF 11 Ci r-4 _�-- " F;� E--- I=— iril U JE F;? EE C -n
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL 81-tl THIS
DEPARTMENT WILL. BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGiE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 1.50 TO 200 FEET FROM A PUBLIC I -JELL DEPENDING
UPON THE TYPE OF PUBLIC [,JELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE 15 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE RE(.-�UIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F�EE-F:1411-1 I -F 1 rRI—Ef-S, :lr::L, 2-e
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SE14ERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES,.
3: 1 Ut-,IDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIF,.E ENLARGEMENT IF THE
RESIDENCE IS REP10DELED TO INCLUDE MORE THAN 3 BEDROOMS.
S I GNED:..-," ---------- L
APPLICANT DA%-'jI::, ALLEN
DA
%04. Ed
ISSUED BY-_ TE----
XSOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG PERCOLATION TEST
PERFORMED FOR: F f -A -C-- 1") DATE PERFORMED:At-�-A z
LEGAL DESCRIPTION: )41
SLOPE SITE PLAN
FDEPT"
T"
(F7EP7rT�
I
2
3
4
5
6
7
8 00
10
11
12
13
14 -
15 -
16
17
18 -
19-
20
COMMENTS
o -
WAS GROUND WATER
ENCOUNTERED? 0 Uv
IF YES, ATWHAT
�7 r)1/11 ol- f-4 (j). i--� DEPTH?
4 �.z "vy
�"'% 41.
Robert f
NO. I
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN --
PERFORMED BY: CERTIFIED B
Ony)
72-008 (6/79)
(minutes/inch)
D -- FT
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
'relophone264-4720
825 L Street- Anchorage, Alaska 99501
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE EW
UPGRADE
MAILING ADD-RESS
e!��h (Oor,
LEGAL DESCRIPTION
4aoAj
-rx-r-/
LOCATION
NO. OF BEDROOMS
a�1-7�— &-)e>C 6al- o cs—
DISTANCE TO:
Wjl 6d
Abso�p;,io�Fa
'-6-ru&P0F_IERMIT
2)
NO.
P z
0. <
Ul I.-
Manufacturer
C�
Materiaj
No. of compartments
to
Lic. capacity in gallons IF HOMEMADE: Inside length Width
Liquid depth
Nell Dwelling
PERMIT Nj.
02<
Manufacturer Material
Liquid capacity in gallons
T l -
D
_j
Lu X
DISTANCE TO:
Foundation
Nearest lot line
IL
-
PER��T NO
21
W
J
No. of lines
ength of each Iihe
'749'
Total h/ of lilies
-French width
Distance between lines
�: LU
riches
< Cc
Top finish
Material beneath tile
Total effective absoiption area
cc 1--
of tile to grade,
-3 6?
-
(3
/
aZ inches
!T3 a :5� 7
Length
Width
Depth
PERMIT NO.
LU
X lr-
Type of crib
Crib diameter
Crib dept -11---
Total effective absorption area
C� 3:
LU
Lu
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
_j
i:
I DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
(�26)e' 'a 5-r;;tq :303�1
SOILTEST RATING
14- ;57- 9>�*
f_�
fAk
INSTZF'
REMARKS:
r
no
Or i
CQ
01
>
.09. 00.
ol
RUSSIA L. Oyster (�"c
No. /l2 3
N\
I?OrFs
PPROVED DATE
LEGAL
7
C11
1___1
TYPE OF SOIL HBSOR8TlON SYSTEM IS TRENCH
MHXIHUM NUMBER OF BEDRUOSUIL RHTII'M (SQ FT/0P)= 145
THE REQUIRED SIZE OF THE Sl ],I CAYMAN [KEY SYSTEM IS:
������ 09 �pl� 140 oil T P -A= ?" To w Do 4 0 1 0 V k � � 1^ ����1! 11^U :: : :
THE LENGTH DlMENSION IS THE LENGTH (IN FEET) UF THE TRENCH OR DHHlHFlELh
THE DEPTH OF H TRENCH UR PIT IS THE DlSTHNCE BETHEEN THE SURFRCE OF THE
GROUND HND THE RID TTOM OF THE EXCGvRTI0N !IH FEET)
THERE IS NO SET WIDTH FOR TREHCHES
THE GRRYEL UPTH IS THE MINIMUM DEPTH UF GRHVEL IDE TNEEN THE 01!T1 IHL1 lPE
HND THE BOTTOM 0F THE EXCHVHTION (IN FEET)
Y YppWQil1-w;j; �!::i�ii j _ 11,'����
INION IT SON PLICHNT HHS THF RKSPUNS1G[L(TY TU INFMV, THIS DE"FOR TMENT DURIHG THE
INSTHLLHTI0N INSPECTIONS OF HNY END. 1. HDJHCENT TO lHlS road P[RTY HND 7HE
NUMBER OF RESIDENCES THHT THE NELL WIL/. SEHVE
'Fq Q Q n W7 it: NJ Y47 4 " Kv� g! 1 1'1: 1 A "M 71 � 00 W� & j 1 V W 47 0 1. 1 C I Q E n�
6HCKFILLING OF HNY SYSTEM W[THOUT F(NHL lMUM( T[N AND HPPRO;H| 8Y THIS
DEPRRTMENT WILL VOL SU8JECT TO PRO�ECUTIO�
MINlMY! DlSTHNCE WTNEEN H WELL HND HNY ON-SITE SEWRGE |)IS"NA HL t �YSTF� �S
100 FEET FOR H PRIVHTE NELL/ 0R
j50 TO 200 FEET FROM R 1 :'U81,lC WELL DEPENDING UPON THE TYPE OF 1 :1 8i IC i'lEiL
0T11ER REQUIREMENTS K1 FOP HPPLV SPECIFICRTI(AAS HND CVMS TRUCTlON DIHGSHHo RRE
HVRILH8LE TO INSURE PROPER INSTHiLHTIONE
1 CERT]FY THHT
i� I HM FHMILIHR WITH THE REQUlREMENTS FOR ON-SITE SEWERS WELLS HS SET
FOOTH 841 THE MUNlCIPHLITY OF HNCNORRGE.
2� I WILL 11, 1 HLL THE SYSTEM IN 1 CC0RDRNCE ITH THE CODES
]� I UNDER�THND THHT THE ON~SITE SFWER SYSTEM MHY REQUIENLHKGFMEHT lF THE
RESIDENCE��`REMODELFI) TO TNCLUDF MORE THHN l BO
EDROMS
\�HPPy�1� NS
"kkz K . (F ..... 1i'l i i 1 F - x
0 & E ENGAEERING & DEVELO1.41ENT CO.
Box 90, Davis St., Eagle River, Alaska 99677
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performedfor: Name: P4 t, /,, E D4 -_- 4 & S -Tel. No. 6 � V-7 MOU
MailingAddress: /90X o f, �Elq C7 6, a A?/ 4 A /,< - �' �'s - -;, -7
AdVA4 A10
Legal Description: C, 111e71'161q1V,0 .4
Depth (feet)
0 —
Soil Characteristics
I — Z5'/'�-rp /::/_/Ve
2 Z
3
4
5
8 kT
9— 7-6
10 — -7
12
13
14
15
16
Ground Water Encountered: Yes_k_�'No_ lfyes,whatdepth /0 /
Proposed Installation: SeepagePit— DrainFleld__
Comments:
PLOT PLAN
t4o '5C41LE-
PERC.TEST
—1
Performed by:
If 1!
L: 1 1 1 lil 1 J_ Fl !'.jf-'
ILI If 0 u Lo (D q .
MR -M
1� �:v;
I.J
A t
It
It
44
all,
4
.14ti .4
0 o
It
WA
LI
-rq "0'
Ij
tA
I I
ILL
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
+F 343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Co 2 -),a
Parcel I.D. # ZL) - S � \ - Q S HAA # 0 C)'\ \ (�11
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block subdivision, section, township, range)
Highland Terrace Subd. Tract 6C-1, T14N, RlW, Sec. 7
Location (address or directions)
11247 SteeDle Drive, Eagle River
(b) Property owner Bruce Ca—meron — Telephone : (home) 694-34B3 Business N/A
MailingAddress P.O. Box 772:i0'3' Eag__ Rivar,-AE. 1-20! 11 1
(c) Lending Institution Cjty Eart-gage-_ Telephone 563-0700
Mailing Address P-0- Box 9?81 , Anchorage_,_AK__aaHQ9=28_L0_—
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here 0, if hold for pick up.)
List contact person and day phone number below:
Laura, Eagle River Engineering Svcs. 694-5195
2, TYPE OF RESIDENCE
Single -Family P
3. WATER SUPPLY
Individual Well IR
Number of bedrooms I "\j
Community 0 Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4, SEWAGE DISPOSAL
On-site R] Public El Community El Holding Tank 11
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
E jo E aft'd �OUS (991L AGU) WO -U
-Niom s,jeE)ui5ua jeuoissajoid aq; ui
suoissiwo jo sjoija jol elqlsuods;Dj jou si a5ujoqouVjo Ajjjedioiun�N aqi,panssi si aluoip1jeo e ajopqelep azAleuejo
suoiloadsui Ion puoolouOPSHH 0 josaGAojdw3 -sluawaiinbei @leis pue jwapaj uiuljooAjsilLsoliepiouisuoilnl!lsui
buipual ji@qj pue s�woq jo sjoseqoind ol Asalinoo e su SM SOOP SHHO aL4i T�SPIV JO Glels aql Ul paialsibei
jaguibue peuoissajoid luepuedepui ue Aq GAoqe 9 tideiftied ui UGA15 suoilBluasajdai aL41 uodn Aluo pasiaq paleoilpao
JeAojddV Al!joL4lnV qllBGH sanssi (SHHG) SOOIAA@S uewnH PuB qllu@H jo juawpeda(] a6eAot4ouV;o Aj!jedioiunVj E)LI.L
7. NoijLnva
7 ryp BAojddV JeuoIj!puoO 10 swiaj
jeUOIj!PUOO PGAoiddesici P9AojddV
x
Cj SwooApaq JOI P@Aoiddv
01BG
IVAOUddV SHHC'9
ze,
ale(]
LLS66 NV 'JOATE @T02S'�6ULL X09 'O*d ssaippv
S6TS—M9 auo,4d8ja-L - SDAS bUTa�)�UTJDUH aGAT�j @TbUR wJl-� 10 OweN
-uoijoE)dsui siql 10 alep aqj uo joa�ja ui suojlelnf)E)i pue 'seoueuipio 'sapoo alels
pue lediownVI Ile ql!m eoueildwoo ui si walsAs jusodsip jalemalsem jo/pue Ajddns jalum al!s-uo oql 'uoiloodsui
Pue Uopol,)SOAUI AW woj� pue sal!j @6ejoqouV jo Aj!jedioiunVj aqj woAj pauielqo uoi;eWJOjUI aqj uo paseq
JUqj Aj!AGA japinj I 'uiajaq paieoipul ainjonils jo adAl pue swoojpaq jo jaqwnu aqj jo; alenbape pue jeuoijounj
'ales si WeisAs pasodsip jalemalsem jo/pue Alddns jalem E)I!s-uo E)ql IPql SmOL4s JeAojddV Al!joqlnV qjjeaH
sl
.qj 10 UOIjI?6IjSGAUi Aw leql A;!J@A I'molaq umOqS Glep U011ep!IeA Gql;O SU PUe 019JGq paxillig jeos Aw Aq paipliao sv
NOUVVYHO:INI (INV V-LVCJ 'HOUV3S 3-IIJ 'S.LS3.L 'SNOI.LO3dSNI !DNiaIAOHd MIA UNIM33NION3 'S
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Te r �-,i
A. WELL DATA
Well Classification TF
Well Log Present (Y/N) /V Date Completed
Total Depth Cased to 20e-e—�' Depth of Grouting
Static Water Level ___/Z_S� Pump Set At /- --a C_r "
Casing Height Above Ground _'1Y Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
/ '�' t) /Z i "') S e ,
/-/, � /' 4 � — '-�
If A, B, C, D.E.C. Approved (Y/N) /L/
14
Yield
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots
To Nearest Public Sewer Line /' �4 To Nearest Public Sewer Cleano ut/Man hole
To Nearest Sewer Service Line on Lot /--I S� - /
Water Sample Collected by Date
Water Sample Test Results < 0.
Comments
A�)
B. SEPTIC/HOLDING TANK DATA
DateInstalled 1�72? Size /OLO"J"t No.of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) 1.4 ; for
Holding Tank High -Water Alarm (Y/N) " /V Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 13S- To Building Foundation
To Property Line '�'_ 5 To Disposal Field
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 2Y
Width of Field 3� –
Type of System Design
— Length of Field 7-
- Depth of Field 6" J_
Gravel Bed Thickness
Square Feet of Absortion Area Statndpipes Present (Y/N) — Y
Depression over Field (Y/N) /V Date of Last Adequacy Test
S �, r _4 /� d � , 4,,5v� 1 4 &- /,�_ '?
Results Of LaSL Adequacy I eSL _;Z
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well / 5–,) /
To Building Foundation
To Property Line /, /,�?
To Existing or Abandoned System on
11
Lot A/ Al On Adjoining Lots
To Water Main/Service Line To Cutback (if present) 5
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION 11-114
Date Installed
Size in Gallons
"Pump On" Level at —
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
— Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request"
ff. ecit'8,1� ate
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines inle. h of this
inspection.
Signed
Company
Eagle River Engineering services
P, 9. lox
/1,
Eagle River, AK 99577
lei
ne&'s Seal
Date
1 694-5195
MOA No.
k e .0
0_� I-,
Receipt No. Receipt No. —
Date of Payment Waiver Fee: $
Amount: $ Date of Payment
72-026 (Rev. 7/8B) Back Page 2 of 2
Eagle River Engineering Services
11940 Business Blvd, Suite #205
A P.O. Box 773294 694-5195
Eagle River, Ak. 99577 Fax 694-3297
Legal: F�- � � 5�-
Owner*. 6,4 � 0 Date:
Type of test:
0 Well Flow Test 0 Septic Test Only -W-Well & Septic Test 0 Other:
Time
Meter
Reading
Monitor
Level
AA"C 01",
Well
Level
Tank
Level
GPM
PSI
Remarks
-TT
-67
-3 7" f
141y
-3 '5
D- 0 7 S-0
23
-2
:2 ;13
-3 .2
9.0
/ , Is-
'3
5- j -
0, S- Lrr
:13
S ep 'je 1-( e
3 Y : I D-
4; 33-5 3'
3: (�
6 01
ar, "'Va
/
3?: C)i
lk�
/* 7
Z A
1-1 L -P'
P. 1 2
NOR 'RN TESTING LABORATORIES, INC.
�mo iNDUSTMAL V;po FAMHANKS, ALASKA �r,)-/01 (907) 456-3116 - FAX 456-3125
MIIAANKI� f ANCHORAGr. ALASKA VJ5a3 (907) 277-M78 , FAX P74-9646
I,! �� i , . �' I � n �j iT)Rf?
vt' 9 9 1� -1
Otte , �, '5
ar tj
Anc�i�
A 108 301
, �.!' i" I ? "
W"
D�%,L P� Arr i vod 02/04/91
Date j- 'J W/04/91
1 12 0 b
Y) f i n i t I cin u
U bolow D"t'kct J -110-L
W, 6tat,tici � �ml t'
B Below Reciti L41 01--v min
H Abovc.- Roquj'Atory M�Ax
flf�!low Detect lon
D � t' k�
Arl'i I yz�.d
- - - - - - - - - -- -
Ing I U J) /'04 /9 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
1. GENERAL INFORMATION
2.
Application Date Feb)tualty 26, 1987
(a) Legal Description (include lot, block, subdivision, section, townshiapffl�ge)'
Titact 6CI; Hightand Tekkace Subdivi6ion !0&
Location (address or directions)
Steepte D)tive o66 Eagte Rive)t Lane
(b) Applicant Name _VaveAtten -_ - Telephone: Home 694-2060 Business
Applicant Address P.O. Box 771432, Eagte Rivn, Ataska 99577
(c) Applicant is (check one): Lending Institution D ; Owner/builder d ; Buyer E3 ; Other 0 (explain);
(d) Lending Institution Ataska Mutuat 8ank Telephone
Address
(e) Real Estate Company and Agent Fo)Ltune PiLope,%ties/Vave Buck
Address — Ancho4age, A.Wka
Telephone
M W the HAA to the following address:
S 9 S ENGINEERING
17034 Eute Rivelt Loop Road, Suite 204
EaqZe Rivek, Ataska 99577
TYPE OF RESIDENCE
Single -Family ff Multi -Family 0
Number of Bedrooms 3
3. WATER SUPPLY
Other
Individual Well IK Community 11 Public 71
Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite KI Public D Community 11 Holding Tank 71
Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 7M25 (11;84)
5. ENGINEERING FIRM PROVIDII NSPECTIONS, TESTS, FILE SEARCH, Dk 4ANDINFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm S & S ENGINEERING Telephone
Address 17034 Eagle River Loop Road No. 20,11
hagle Rivar, Alaske 99517
Date
6. DHEP APPROVAL
Approved for
Approved
-74A bedrooms by !4F�' Date
1�� Disapproved Conditional
Terms of Conditional Approval
CAUTION
A�
%
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work,
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOm)
of ANCHqi6iT
,X AUTHORITY APPROVAL (HAA)
MUNICIPA, 4�CES DINIISIOCHECKLIST - FEBRUARY 1984
1EJ4\11Ro"'*fN'a 264-4720
6 Legal Description: 0C
I // -
A. WELL DATA 'fc�
Well Classification S If A, B, C, D,E,C. Approved (Y/N)
Well Log Present&9N) Date Completed __F� — Yield
Total Depth Cased to Depth of Grouting
Static Water Level / 7t; Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit &N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
/ ?_ P I
Sanitary Seal on Casing CWN)
Depression Around Wellhead IWO
; On Adjoining Lots 4 0 C>
To Nearest Edge of Absorption Field on Lot /00/'C _; On Adjoining Lots
To Nearest Public Sewer Line — To Nearest Public Sewer
Cleanout/Man hole To Nearest Sewer Service Line on Lot 4
Water Sample Collected by L� / Ai L:� L�� i to Date
Water Sample Test Results T- I
Comments lllc�i.6 �P—C*-_MRL?
B. SEPTIC/HOLDING TANK DATA
Date Installed /—OZQ7 Size /000 No. of Compartments e—
Standpipes (by N) / , — Air -tight Caps (9/N) Foundation Cleanout (Y)N)
Depression over Tank (Y(@ Date Last Pumped 3 / 5LO 7-
M1 V/K1 �VIA 4 for x1lA
rUmping/Maimenance Comrac on e � I —
Holding Tank High -Water Alarm (Y/N) A -11A Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank
To Water -Supply Well /oo
To Property Line - / j)
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation
To Disposal Field
IV14
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed Z7 -
Width of Field
S�rl _Z_K // J_J
Square Feet of Absorption Area 5 3 Z_ 1h
Depression over Field (Y&
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well -4
To Building Founclati 0
tj
Lot
To Water Main/Service Line 10(4 —
To Stream/Pond/Lake/or Major Drainage Course -
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
I ype ol bystem DesJgn
Length of Field 7&
— Depth of Field 6.
Gravel Bed Thickness
— Standpipes Present (&N)
Date of Last Adequacy Test
To Property Line 3c) /
To Existing or Abandoned System on
On Adjoining Lots 3c) 1-4-
- To Cutbank (if present) oe�v�
Date Installed
Dimensions
Size in Gallons
Manhole/Access (Y/N)
"Pump On" Level at tQ
"Pump Off" Level at
High Water Alarm Le
Vent (Y/N)
Tested for
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
gte-Rive,'
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certifythat I have checked, verified, orconformed toall MOAand HAAguidelines in effect on the clateof this inspection
Signed S&SENGINEERING
Date
17034 Eagle RI.ver Loop Road No. 204
Compan)k a Alaska 99
577 M CA No. CIO
gte-Rive,'
Receipt No.
Date of Payment
Amount: $
i n r's
Page 2 of 2
72-026 (11/84)
rl'dJ A-) n 1) I)Q), r-
1, 10-, 1 0 P( I
5. LEGAL DESCRIPTION
DATE RECEIVED
INSPECTION APPOINTMENTS
C
TIME
TIME
TIME
)c,,c
NUMBER OF,BEDROOMS
oSAQ_
m'-'
DATE
'ic) )
_Q_'y
DATE
"kn
7. WATER S PLY
INSPECTOR
INSPECTOR
INSPECTOR
PA01,41CIPAMIT ur AI!CIl5RA5E
MUNICIPALITY OF ANC140RAGE DEPT. OF 1! ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECTMII�ONMENLM. r�.OIECTION
825 L Street - Anchorage, Alaska 99501
JAN 1 1 1980
0*
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. (L61 _a��
1. PROPERly OWNER c=/j P� NE
6,// 0 �
MAILING 6�RDRESS —
/77/4
PROPERTY RESIDENT (if different from above)
PHONE
;�;Wncr 5-6/6
2. BUYER
PHONE
MAI LI NG ADIDR ESS
3. LENDING INSTITUTION
HONE
/__VC A-CJCA [')/�) / em� c e —=P
MAILING ADDRESS
po U04 1-10
4. REALTOR/A ENT
NE
P� f)
MAILINGADIDNESS
5. LEGAL DESCRIPTION
TQA c� 6 L
C
STREET LOCATION
P o Lt -
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
EEr' SINGLE FAMILY
0 One 0 Four Ell Other
0 Two El Five
11:1 MULTIPLE FAMILY
2�' Three El Six
7. WATER S PLY
INDIVIDUAL*
ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
El PUBLIC UTI LITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
E�Y IN DIV] DUAL/ON-SITE**
e!!�l '2'_9 YEAR ON-SITE SYSTEM WAS INSTALLED.
0 PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
L j
72-010 (Rev. 6/79) k\
79-n1n (R.� R/7c))
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
Cl SINGLE FAMILY
E] ONE
ED THREE EJ FIVE
El OTHER
EJ MULTIPLEFAMILY
0 TWO
0 FOUR 0 six
2. WATER SUPPLY
PERMIT NUMBER
0 INDIVIDUAL
DEPTH OF WELL
0 COMMUNITY
DATE DR I LLED
E:1 PUBLIC UTILITY
Connection Verified_
LOG RECEIVED
�24
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
DINDIVIDUAL/ON -SITE
DATEINSTALLED
OPUBLIC UTILITY
e-,
Connection Verified
INSTALLER
-
ElSeptic Tank or 0 Holding Tank
Size: )0,00 If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
ptic/Holding Tank
Absorption Area
Sewer Line 77
ot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
V/APPROVED
FOR BEDROOMS
0 CONDITIONAL APPROVAL
(letter must accon�W
Lrtificate)
�K ISAPPROVED
7
DATE
ff
Q.
79-n1n (R.� R/7c))